Will we have enough GPs in the future? Yes, if we make them competent and keep them happy!

The role of General Practitioner is a less popular choice of medical specialization throughout Europe. In a study recently published in BMC Family Practice, researchers explore and highlight the positive factors that support the satisfaction of active General Practitioners.

The low appeal of General Practice (GP) and primary care as a career option is a recurrent difficulty for healthcare systems throughout Europe. The European Commission projects that the shortage of health workers across the European Union will increase to more than 2 million by the year 2020 if nothing is done to improve measures for recruitment and retention of the workforce. Without this, 13.5% of Europe’s health needs will fail to be met. This shortage is particularly high in rural areas of European countries, most notably in France. Moreover, in several countries, 50% of all general practitioners are over 50 years of age.

Research into retention and recruitment of General Practitioners has so far mainly focused on negative factors without any improvement in the size of the workforce. An innovative path was to look at the positive elements that encourage young people to choose general practice and which support GPs already in practice in a bid to increase motivation to continue their clinical work.

Consequently, this study recently published in BMC Family Practice and supported by the European General Practitioners Research Network (EGPRN), explored job satisfaction among GPs in seven European countries, and in Israel, by asking the following question: What contributes to job satisfaction for the GP workforce?

Six main themes were found during the analysis.

The GP as a personA GP is a person with intrinsic characteristics. these include an interest in people’s lives and a strong ability to cope with a variety of situations and a variety of patients. GPs love their work and their patients.

GP skills and competences needed in practiceAll GPs told us about the need for specific skills for diagnostic reasoning and for coping with uncertainty, for communication and for achieving a correct diagnosis with low technical support. The profession is challenging and offers a broad spectrum of experiences. Together with long-lasting doctor-patient relationships, this was listed as one reason to make general practice attractive. One GP said: “This is intellectually extremely stimulating and challenging work”.

With a good GP, patients expect respect and mutual trust. To be a GP you need a lot of love.

Doctor-patient relationshipsRecently, an older French GP said in the media: “with a good GP, patients expect respect and mutual trust.To be a GP you need a lot of love”. This is exactly what was found in the study. Rewarding interpersonal relationships, with mutual trust and respect, contributed positively to GP self esteem.

Supportive factors for work-life balanceSatisfied GPs need a good family life not restricted to a healthy work-life balance. The living environment is as important, with sufficient facilities for leisure pursuits and schools for the children. An efficient doctor is self-sufficient but does need other people’s perspectives and opportunities for discussion with colleagues.

Teaching in general practiceTeaching students and young colleagues is a positive challenge for GPs and they feel gratified when universities recognize the value of their discipline.

Autonomy in the workplaceThe freedom to choose their practice location is an issue of major importance and conflicts with the need for GPs in rural areas. GPs also needed well-functioning, inter-professional networks. This was illustrated by a Bulgarian GP: “This is the most important issue in our practice: that I decide when and how to work”. This may well be part of the problem why rural regions are not attractive to young GPs.

How can we use these results to attract and retain GPs?

This article is a wake-up call for everybody who loves general practice.

This article is a wake-up call for everybody who loves general practice. Starting with the selection of young people who have a strong intrinsic motivation. Universities should stress the scientific dimension and the added value of general practice, instead of cultivating a negative perception. Additionally, policymakers should respect GPs in the same way. It is time that Europe took responsibility for promoting the recognition general practice deserves as a difficult and invaluable specialty in every country. This would then motivate universities to have a specific faculty of General Practice led by full professors of General Practice. This is the only way to train students in specific GP skills and competences and to organize traineeships in primary care practices and not in hospitals.

The intrinsic motivation factor, within the ‘GP as a person’ theme, is one key to achieving satisfaction in this profession.
There is a need to think about how these characteristics can be taken into account in the medical students selection process.
The Supportive factors for work-life balance should be taken into account by all stakeholders to attract GPs to the workforce, including providing well-organized out-of-hours services.

Autonomy in the workplace should not be forgotten and is a highly significant requirement in the drive to retain and to attract a strong GP workforce. Until now, most policymakers have tried to stimulate young GPs to start a practice in a rural environment by offering financial incentives. However, money will not solve this problem and more creative solutions are necessary. One possibility is to rethink new practice formats: larger practices with facilities in main centers of habitation within rural areas. Local governments can support young GPs in their search for appropriate practice locations.

General practice is challenging and extremely intellectual and needs the best students to handle global care.

Comments

Bernard Le Floch is a general practitioner in Guilvinec, France and professor at the Department of Primary Care of the University of Brest. He is also a member of the research team EA 7479 SPURBO and conduced the collaborative study “Womanpower” with the European General Practitioner research network, which is the subject of his PhD. Le Floch’s main field of interest is on General Practitioners’ job satisfaction.

Hilde Bastiaens is a primary healthcare practitioner, researcher, associate professor at the department of Primary and Interdisciplinary care of the University of Antwerp, and president of the University Centre of Qualitative Health Research Antwerp.

Jean Yves Le Reste is a general practitioner, professor at the Department of Primary Care of the University of Brest, and director of the research team EA 7479 SPURBO as well as the department of Primary Care of the University of Brest.

Lieve Peremans is a general practitioner and associate professor at the Department of Primary and Interdisciplinary Care as well as the Department of Nursing and Midwifery of the University of Antwerp.

Heidrun Lingneris a General Practitioner, Master of Public Health, and Associate Professor at the Centre for Public Health and Healthcare of the Hannover Medical School.

Robert D Hoffman MD is a specialist in Family Medicine working in Rehovot, Israel and is a teacher at the Family Medicine Department at Saklar School of Medicine, Tel Aviv University.

Zalika Klemenc Ketiš is a family medicine specialist working in the Community Health Centre Ljubljana, Slovenia and is associate professor and a chair of the Department of Family Medicine at the Faculty of Medicine, University of Maribor, Slovenia.

Radost Asenova is a certified family physician by the Medical University of Plovdiv, Bulgaria with her main interests being in the field of Patient-Centred approach, prevention, multimorbidity and geriatrics.

Slawomir Czachowski is a general practitioner, paediatrician, associate professor and chair of the Department of Clinical Psychology at the Nicolaus Copernicus University, Torun, in Poland.